Common bile duct stones in sickle-cell disease - abstract

ABSTRACT

Common bile duct (CBD) stones were found intra-operatively in 12 patients (11 SS, 1 SC) among 36 patients with homozygous sickle-cell (ss) disease and 2 patients with sickle-cell haemoglobin C (SC) disease subjected to cholecystectomy between January, 1985 and December, 1992. Pre-operatively, ultrasonography had identified common bile duct stones in only 5 of these 12 patients. Operative cholangiography was diagnostic in 11 and equivocal in one. Following exploration of the common bile duct, immediate closure was performed in one, transduodenal sphincteroplasty in one, insertion of a T-tube in 4, and choledochoduodenostomy (CDD) in 6. Retained CBD stones were detected in 2 patients on routine T-tube cholangiography performed on the 10th postoperative day, and in both were successfully dislodged by saline irrigation. The high frequency of CBD stones in this symptomatic group of patients receiving cholecystectomy justifies routine diagnostic operative cholangiography. Saline irrigation intra-operatively may successfully remove stones, reducing the risk of iatrogenic damage by ductal instrumentation. Marked ductal dilatation with calculi can be treated successfully by CDD (AU)